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George House Trust operates its own Welfare Fund. This fund is open to applications from anyone known to George House Trust.

George House Trust operates its own Welfare Fund. This fund is open to applications from anyone known to George House Trust.

There is a limited amount of money available each month in the fund and we can only consider applications where it is clear that the item requested will contribute to your health and wellbeing.

Items you can apply for include:

Beds & mattresses

White Goods (cooker, washing machine, fridge etc.)

Clothing

Bedding

Other items that will benefit your health or relieve need

Help with utility bills

ACCESSING THE SERVICE

1. The form should be completed in full. We will not be able to consider your application if you do not answer all the relevant questions.

2. Your application should include as much relevant supporting information as possible about why you need the item(s) you are requesting. This will assist the panel to make a decision about whether or not your application can be granted.

3. Items granted by the panel are supplied as goods only or paid directly to the supplier. This means that we will not award cash, but will arrange for the item to be delivered to your home, collected from George Hoouse Trust or payment of fees etc. to be paid directly to the provider..

RESTRICTIONS

1. If you are living with HIV and living in the North West and have not contacted George House Trust before you must book an appointment with an adviser before applying to the Welfare Fund.

2. We cannot pay for ordinary living expenses from the Welfare Fund, your application must be for a specific item or service.

3. Unless the child is living with HIV, we are sorry, but we cannot pay for children's school uniforms, toys or activities.

4. The maximum value of grants, other than white goods, in any one year from April to March is £150.

5. If you are granted an item(s) from the fund you cannot reapply for other items for another 6 months.

6. For reasons of safety, gas and electric cookers will be professionally installed. We will not grant these items without installation. For your convenience, we also arrange installation of washing machines.

OUTCOME

1. The Welfare Panel meets each month to look at the applications.

2. When you submit the application form, you will see a confirmation message of the date of the next Welfare Panel meeting.

3. We will contact you to let you know the outcome of your application and tell you about the arrangements for payment.

DATA SECURITY

We take data security very seriously. This site is secure and your data is encrypted.

IMPORTANT NOTE: Unfortunately, we will not be able to grant a cooker, washing machine, fridge/freezer or bed frames as you are currently living with friends/relatives, in temporary accommodation or hostel or are homeless. Please make an application for any one of these items when you are in permananet accommodation with a private or housing association tenancy agreement and where this item is not included on the inventory or supplied as part of a furnished or part-furnished let.

You can continue with your application for other items.

SOURCES OF INCOME

Please tick all that apply. You will not be asked to say how much salary or benefit(s) you receive.

Income *

Salary

Jobseekers Allowance

Employment and Support Allowance

Income Support

Universal Credit

Child Tax Credit

Child Benefit

Housing Benefit

Council Tax Support

Disability Living Allowance

Personal Independence Payment

Attendance Allowance

Retirement Pension

Pension Credit

Carer's Allowance

Other Benefit

NASS Support

Social Services Support

George House Trust Destitution Payment

No Income

BENEFIT COMPONENT

Employment and Support Allowance

assessment rate

work group

support group

Child Tax Credit: how many children do you have?

1

2

3

4

5

More than 5

Child Benefit: how many children do you receive child benefit for?

1

2

3

4

5

More than 5

Disability Living Allowance

Care Component - high rate

Care Component - middle rate

Care Component - low rate

Mobility Component - high rate

Mobility Component - middle rate

Mobility Component - low rate

Personal Independence Payments

Daily Living Expenses - standard

Daily Living Expenses - enhanced

Mobility Component - standard

Mobility Component - enhanced

Attendance Allowance

high rate

low rate

Other Benefits

Enter the name of the other benefit(s) you receive

EXPENSES

If you have any unusual or high expenses, including debt repayments that impact heavily on your budget, tell us about them here. We may be able to provide additional services to help your debts be managed, including negotiating payment plans or sourcing other means to reduce your outgoings.

Expenses

ITEMS

IMPORTANT NOTE: The item selected here will be considered by the Welfare Panel to be your preferred or priority item. We can only grant ONE item marked with *. If you are making an application to the Welfare Fund for two items and each item is marked with an *, we will only consider your application for the item you have selected here.

Priority Item *

Unfortunately, we will not be able to grant a cooker, washing machine, fridge/freezer or bed frames as you are currently living with friends/relatives, in temporary accommodation or hostel or are homeless. Please make an application for any one of these items when you are in permananet accommodation with a private or housing association tenancy agreement and where this item is not included on the inventory or supplied as part of a furnished or part-furnished let.

You can continue with an application for other items by makng another selection for any item not marked with *

Brief Description of what you are applying for. *

Keep this brief. Only tell us what item, or other short description of what you are applying for. You will be able to give further details on the next page.

Is there a cooker in your property currently? *

Yes

No

Is there a fridge/fridge-freezer in your property currently? *

Yes

No

Is there a washing machine in your property currently? *

Yes

No

Please say why the appliance needs replacing *

Welfare Fund: GAS COOKER

You are making an application for a GAS COOKER. You must read the following statements carefully. You will be asked to tick a box to indicate that you agree to these terms. If you are unable to agree to these terms, we will unfortunately not be able to proceed with your application for this item.

I acknowledge that, if my application is successful, the item requested above will be delivered to my home. The goods have been funded by the George House Trust Welfare Fund and the item will be supplied by the supplier chosen by George House Trust.

I understand and agree to the following:

The gas cooker will be fitted by a qualified installer, arranged through the supplier, and I am not permitted to arrange independent installation as an alternative. George House Trust will not supply gas cookers which are not delivered brand new and which are not fitted by the supplier.

The welfare fund will cover the cost of standard installation and there must be a suitable gas supply in the vicinity of where the cooker is to be sited for the installation to take place.

I understand that I will be responsible for any additional charges that may be necessary if a gas supply or fittings needs to be installed or replaced.

My old appliance will be taken away by the installer.

If the item is faulty, or becomes faulty at a later date, I am responsible for contacting the supplier from where the item was bought.

The item will be delivered to my home address. This address is the one recorded on the George House Trust database.

If the arrangements made for delivery at the time of ordering are not convenient for me I am responsible for making any necessary alternative arrangements myself by contacting the supplier on the phone number below.

I am responsible for ensuring that I (or my representative) is at my home address to receive the item when it is delivered.

The make and model of the item will be decided by George House Trust on the basis of the information I have supplied and I will not be able to change or amend the order.

Welfare Fund: ELECTRIC COOKER

You are making an application for an ELECTRIC COOKER. You must read the following statements carefully. You will be asked to tick a box to indicate that you agree to these terms. If you are unable to agree to these terms, we will unfortunately not be able to proceed with your application for this item.

I acknowledge that, if my application is successful, the item requested above will be delivered to my home. The goods have been funded by the George House Trust Welfare Fund and the item will be supplied by the supplier chosen by George House Trust.

I understand and agree to the following:

The electric cooker will be fitted by a qualified installer, arranged through the supplier, and I am not permitted to arrange independent installation as an alternative. George House Trust will not supply electric cookers which are not delivered brand new and which are not fitted by the supplier.

The welfare fund will cover the cost of standard installation and there must be suitable electrical sockets in the vicinity of where the cooker is to be sited for the installation to take place.

I understand that I will be responsible for any additional charges that may be necessary if wiring needs to be installed or replaced.

My old appliance will be taken away by the installer.

If the item is faulty, or becomes faulty at a later date, I am responsible for contacting the supplier from where the item was bought.

The item will be delivered to my home address. This address is the one recorded on the George House Trust database.

If the arrangements made for delivery at the time of ordering are not convenient for me I am responsible for making any necessary alternative arrangements myself by contacting the supplier on the phone number below.

I am responsible for ensuring that I (or my representative) is at my home address to receive the item when it is delivered.

The make and model of the item will be decided by George House Trust on the basis of the information I have supplied and I will not be able to change or amend the order.

Welfare Fund: FRIDGE/FREEZER

You are making an application for a FRIDGE, FREEZER or a FRIDGE/FREEZER. You must read the following statements carefully. You will be asked to tick a box to indicate that you agree to these terms. If you are unable to agree to these terms, we will unfortunately not be able to proceed with your application for this item.

I acknowledge that, if my application is successful, the item requested above will be delivered to my home. The goods have been funded by the George House Trust Welfare Fund and the item will be supplied by the supplier chosen by George House Trust.

I understand and agree to the following:

The welfare fund does not cover the cost of installation of a fridge, freezer or a fridge/freezer and I understand that I will be responsible for any additional charges if I seek professional installation of the appliance.

My old appliance will be taken away by the supplier.

If the item is faulty, or becomes faulty at a later date, I am responsible for contacting the supplier from where the item was bought.

The item will be delivered to my home address. This address is the one recorded on the George House Trust database.

If the arrangements made for delivery at the time of ordering are not convenient for me I am responsible for making any necessary alternative arrangements myself by contacting the supplier on the phone number below.

I am responsible for ensuring that I (or my representative) is at my home address to receive the item when it is delivered.

The make and model of the item will be decided by George House Trust on the basis of the information I have supplied and I will not be able to change or amend the order.

Welfare Fund: TUMBLE DRYER

You are making an application for a TUMBLE DRYER. You must read the following statements carefully. You will be asked to tick a box to indicate that you agree to these terms. If you are unable to agree to these terms, we will unfortunately not be able to proceed with your application for this item.

I acknowledge that, if my application is successful, the item requested above will be delivered to my home. The goods have been funded by the George House Trust Welfare Fund and the item will be supplied by the supplier chosen by George House Trust.

I understand and agree to the following:

The welfare fund does not cover the cost of installation and I understand that I will be responsible for any additional charges if I seek professional installation of the appliance.

My old appliance will be taken away by the supplier.

If the item is faulty, or becomes faulty at a later date, I am responsible for contacting the supplier from where the item was bought.

The item will be delivered to my home address. This address is the one recorded on the George House Trust database.

If the arrangements made for delivery at the time of ordering are not convenient for me I am responsible for making any necessary alternative arrangements myself by contacting the supplier on the phone number below.

I am responsible for ensuring that I (or my representative) is at my home address to receive the item when it is delivered.

The make and model of the item will be decided by George House Trust on the basis of the information I have supplied and I will not be able to change or amend the order.

Welfare Fund: MICROWAVE OVEN

You are making an application for a MICROWAVE OVEN. You must read the following statements carefully. You will be asked to tick a box to indicate that you agree to these terms. If you are unable to agree to these terms, we will unfortunately not be able to proceed with your application for this item.

I acknowledge that, if my application is successful, the item requested above will be delivered to my home. The goods have been funded by the George House Trust Welfare Fund and the item will be supplied by the supplier chosen by George House Trust.

I understand and agree to the following:

If the item is faulty, or becomes faulty at a later date, I am responsible for contacting the supplier from where the item was bought.

The item will be delivered to my home address. This address is the one recorded on the George House Trust database.

If the arrangements made for delivery at the time of ordering are not convenient for me I am responsible for making any necessary alternative arrangements myself by contacting the supplier on the phone number below.

I am responsible for ensuring that I (or my representative) is at my home address to receive the item when it is delivered.

The make and model of the item will be decided by George House Trust on the basis of the information I have supplied and I will not be able to change or amend the order.

Welfare Fund:BED FRAME / MATTRESS

You are making an application for a BED FRAME and/or MATTRESS. You must read the following statements carefully. You will be asked to tick a box to indicate that you agree to these terms. If you are unable to agree to these terms, we will unfortunately not be able to proceed with your application for this item.

I acknowledge that, if my application is successful, the item requested above will be delivered to my home. The goods have been funded by the George House Trust Welfare Fund and the item will be supplied by the supplier chosen by George House Trust.

I understand and agree to the following:

If the item is faulty, or becomes faulty at a later date, I am responsible for contacting the supplier from where the item was bought.

The item will be delivered to my home address. This address is the one recorded on the George House Trust database.

If the arrangements made for delivery at the time of ordering are not convenient for me I am responsible for making any necessary alternative arrangements myself by contacting the supplier on the phone number below.

I am responsible for ensuring that I (or my representative) is at my home address to receive the item when it is delivered.

The make and specification of the item will be decided by George House Trust on the basis of the information I have supplied and I will not be able to change or amend the order.

Welfare Fund:VACUUM CLEANER

You are making an application for a VACUUM CLEANER. You must read the following statements carefully. You will be asked to tick a box to indicate that you agree to these terms. If you are unable to agree to these terms, we will unfortunately not be able to proceed with your application for this item.

I acknowledge that, if my application is successful, the item requested above will be delivered to my home. The goods have been funded by the George House Trust Welfare Fund and the item will be supplied by the supplier chosen by George House Trust.

I understand and agree to the following:

If the item is faulty, or becomes faulty at a later date, I am responsible for contacting the supplier from where the item was bought.

The item will be delivered to my home address. This address is the one recorded on the George House Trust database.

If the arrangements made for delivery at the time of ordering are not convenient for me I am responsible for making any necessary alternative arrangements myself by contacting the supplier on the phone number below.

I am responsible for ensuring that I (or my representative) is at my home address to receive the item when it is delivered.

The make and model of the item will be decided by George House Trust on the basis of the information I have supplied and I will not be able to change or amend the order.

Welfare Fund: WASHING MACHINE

You are making an application for a WASHING MACHINE. You must read the following statements carefully. You will be asked to tick a box to indicate that you agree to these terms. If you are unable to agree to these terms, we will unfortunately not be able to proceed with your application for this item.

I acknowledge that, if my application is successful, the item requested above will be delivered to my home. The goods have been funded by the George House Trust Welfare Fund and the item will be supplied by the supplier chosen by George House Trust.

I understand and agree to the following:

The washing machine will be fitted by a qualified installer, arranged through the supplier, and I am not permitted to arrange independent installation as an alternative. George House Trust will not supply washing machines which are not delivered brand new and which are not fitted by the supplier.

The Welfare Fund covers the cost of a standard installation. Adequate water inlet and waste pipes and an electrical socket must be available in the vicinity of where the washing machine is to be located for the installation to take place.

My old appliance will be taken away by the supplier.

If the item is faulty, or becomes faulty at a later date, I am responsible for contacting the supplier from where the item was bought.

The item will be delivered to my home address. This address is the one recorded on the George House Trust database.

If the arrangements made for delivery at the time of ordering are not convenient for me I am responsible for making any necessary alternative arrangements myself by contacting the supplier on the phone number below.

I am responsible for ensuring that I (or my representative) is at my home address to receive the item when it is delivered.

The make and model of the item will be decided by George House Trust on the basis of the information I have supplied and I will not be able to change or amend the order.

Disclaimer Agreement *

Yes, I agree to the terms set out above

We will not be able to consider your application for the able item without your agreement to the above terms

Grants for clothing are made by store vouchers for £75. You can make up to two claims for £75 for clothing in any one year. We do not make cash payments for clothing.

Bed sets and quilts will be available for collection from George House Trust. Bed sets are plain dyed sets consisting of a duvet cover, pillow cases and a sheet. Quilts will have polyester fibre filling and the TOG rating may vary. We do not make cash payments for bedding or quilts.

Grants for membership fees, eyecare or dental treatment, furniture items, or other items will be made either by direct payment to the provider or by home delivery from the supplier. We do not make cash payments for these items. Grants for carpeting/flooring are most likely to be made by direct payment to the supplier and you will be asked to send us a quotation from your supplier that matches the value you have indicated on your application. Due to the amount of funds available, we are likely to have to cap grants for carpeting/flooring at £250 and if your quotation is for a higher value, we may be able to consider making an arrangement with your supplier to meet the remaining cost, up to our maximum grant, where you are able to part pay the cost. We will not make retrospective cash payments to you for carpeting/flooring you have already had fitted.

Preferred store Mark Up *

Primark

H & M

Dorothy Perkins

Evans

Burton Menswear

Miss Selfridge

Outfit

Top Shop

Top Man

Wallis

How much are you applying for? *£

Enter value to 2 decimal places e.g. 100.00

RESTRICTED ACCOMMODATION?

RESTRICTED ITEM (*)

PROCEED APPLICATION?

ITEM 2

Are you applying for a second item? *

Yes

No

IMPORTANT NOTE: The quantity or value of the applications we receive to the Welfare Fund is often higher than we can grant in any one month. If you apply for a second item, whilst we will always consider your application for your preferred item, we may not always be able to grant the second item as well.

If you have already selected an item marked * as Item 1, please do not apply for another item marked * as the Panel will not be able to consider your application for Item 2

Second Preference Item *

Unfortunately, we will not be able to grant a cooker, washing machine, or fridge/freezer as you are currently living with friends/relatives, in temporary accommodation or hostel or are homeless. Please make an application for any one of these items when you are in permananet accommodation with a private or housing association tenancy agreement and where this item is not included on the inventory or supplied as part of a furnished or part-furnished let.

You can continue with an application for other items by makng another selection for any item not marked with *

Brief Description *

Keep this brief. Only tell us what item, or other short description of what you are applying for. You will be able to give further details on the next page.

Is there a cooker in your property currently? *

Yes

No

Is there a fridge/fridge-freezer in your property currently? *

Yes

No

Is there a washing machine in your property currently? *

Yes

No

Please say why the appliance needs replacing *

Welfare Fund: GAS COOKER

You are making an application for a GAS COOKER. You must read the following statements carefully. You will be asked to tick a box to indicate that you agree to these terms. If you are unable to agree to these terms, we will unfortunately not be able to proceed with your application for this item.

I acknowledge that, if my application is successful, the item requested above will be delivered to my home. The goods have been funded by the George House Trust Welfare Fund and the item will be supplied by the supplier chosen by George House Trust.

I understand and agree to the following:

The gas cooker will be fitted by a qualified installer, arranged through the supplier, and I am not permitted to arrange independent installation as an alternative. George House Trust will not supply gas cookers which are not delivered brand new and which are not fitted by the supplier.

The welfare fund will cover the cost of standard installation and there must be a suitable gas supply in the vicinity of where the cooker is to be sited for the installation to take place.

I understand that I will be responsible for any additional charges that may be necessary if a gas supply or fittings needs to be installed or replaced.

My old appliance will be taken away by the installer.

If the item is faulty, or becomes faulty at a later date, I am responsible for contacting the supplier from where the item was bought.

The item will be delivered to my home address. This address is the one recorded on the George House Trust database.

If the arrangements made for delivery at the time of ordering are not convenient for me I am responsible for making any necessary alternative arrangements myself by contacting the supplier on the phone number below.

I am responsible for ensuring that I (or my representative) is at my home address to receive the item when it is delivered.

The make and model of the item will be decided by George House Trust on the basis of the information I have supplied and I will not be able to change or amend the order.

Welfare Fund: ELECTRIC COOKER

You are making an application for an ELECTRIC COOKER. You must read the following statements carefully. You will be asked to tick a box to indicate that you agree to these terms. If you are unable to agree to these terms, we will unfortunately not be able to proceed with your application for this item.

I acknowledge that, if my application is successful, the item requested above will be delivered to my home. The goods have been funded by the George House Trust Welfare Fund and the item will be supplied by the supplier chosen by George House Trust.

I understand and agree to the following:

The electric cooker will be fitted by a qualified installer, arranged through the supplier, and I am not permitted to arrange independent installation as an alternative. George House Trust will not supply electric cookers which are not delivered brand new and which are not fitted by the supplier.

The welfare fund will cover the cost of standard installation and there must be suitable electrical sockets in the vicinity of where the cooker is to be sited for the installation to take place.

I understand that I will be responsible for any additional charges that may be necessary if wiring needs to be installed or replaced.

My old appliance will be taken away by the installer.

If the item is faulty, or becomes faulty at a later date, I am responsible for contacting the supplier from where the item was bought.

The item will be delivered to my home address. This address is the one recorded on the George House Trust database.

If the arrangements made for delivery at the time of ordering are not convenient for me I am responsible for making any necessary alternative arrangements myself by contacting the supplier on the phone number below.

I am responsible for ensuring that I (or my representative) is at my home address to receive the item when it is delivered.

The make and model of the item will be decided by George House Trust on the basis of the information I have supplied and I will not be able to change or amend the order.

Welfare Fund: FRIDGE/FREEZER

You are making an application for a FRIDGE, FREEZER or a FRIDGE/FREEZER. You must read the following statements carefully. You will be asked to tick a box to indicate that you agree to these terms. If you are unable to agree to these terms, we will unfortunately not be able to proceed with your application for this item.

I acknowledge that, if my application is successful, the item requested above will be delivered to my home. The goods have been funded by the George House Trust Welfare Fund and the item will be supplied by the supplier chosen by George House Trust.

I understand and agree to the following:

The welfare fund does not cover the cost of installation of a fridge, freezer or a fridge/freezer and I understand that I will be responsible for any additional charges if I seek professional installation of the appliance.

My old appliance will be taken away by the supplier.

If the item is faulty, or becomes faulty at a later date, I am responsible for contacting the supplier from where the item was bought.

The item will be delivered to my home address. This address is the one recorded on the George House Trust database.

If the arrangements made for delivery at the time of ordering are not convenient for me I am responsible for making any necessary alternative arrangements myself by contacting the supplier on the phone number below.

I am responsible for ensuring that I (or my representative) is at my home address to receive the item when it is delivered.

The make and model of the item will be decided by George House Trust on the basis of the information I have supplied and I will not be able to change or amend the order.

Welfare Fund: TUMBLE DRYER

You are making an application for a TUMBLE DRYER. You must read the following statements carefully. You will be asked to tick a box to indicate that you agree to these terms. If you are unable to agree to these terms, we will unfortunately not be able to proceed with your application for this item.

I acknowledge that, if my application is successful, the item requested above will be delivered to my home. The goods have been funded by the George House Trust Welfare Fund and the item will be supplied by the supplier chosen by George House Trust.

I understand and agree to the following:

The welfare fund does not cover the cost of installation and I understand that I will be responsible for any additional charges if I seek professional installation of the appliance.

My old appliance will be taken away by the supplier.

If the item is faulty, or becomes faulty at a later date, I am responsible for contacting the supplier from where the item was bought.

The item will be delivered to my home address. This address is the one recorded on the George House Trust database.

If the arrangements made for delivery at the time of ordering are not convenient for me I am responsible for making any necessary alternative arrangements myself by contacting the supplier on the phone number below.

I am responsible for ensuring that I (or my representative) is at my home address to receive the item when it is delivered.

The make and model of the item will be decided by George House Trust on the basis of the information I have supplied and I will not be able to change or amend the order.

Welfare Fund: MICROWAVE OVEN

You are making an application for a MICROWAVE OVEN. You must read the following statements carefully. You will be asked to tick a box to indicate that you agree to these terms. If you are unable to agree to these terms, we will unfortunately not be able to proceed with your application for this item.

I acknowledge that, if my application is successful, the item requested above will be delivered to my home. The goods have been funded by the George House Trust Welfare Fund and the item will be supplied by the supplier chosen by George House Trust.

I understand and agree to the following:

If the item is faulty, or becomes faulty at a later date, I am responsible for contacting the supplier from where the item was bought.

The item will be delivered to my home address. This address is the one recorded on the George House Trust database.

If the arrangements made for delivery at the time of ordering are not convenient for me I am responsible for making any necessary alternative arrangements myself by contacting the supplier on the phone number below.

I am responsible for ensuring that I (or my representative) is at my home address to receive the item when it is delivered.

The make and model of the item will be decided by George House Trust on the basis of the information I have supplied and I will not be able to change or amend the order.

Welfare Fund: VACUUM CLEANER

You are making an application for a VACUUM CLEANER. You must read the following statements carefully. You will be asked to tick a box to indicate that you agree to these terms. If you are unable to agree to these terms, we will unfortunately not be able to proceed with your application for this item.

I acknowledge that, if my application is successful, the item requested above will be delivered to my home. The goods have been funded by the George House Trust Welfare Fund and the item will be supplied by the supplier chosen by George House Trust.

I understand and agree to the following:

If the item is faulty, or becomes faulty at a later date, I am responsible for contacting the supplier from where the item was bought.

The item will be delivered to my home address. This address is the one recorded on the George House Trust database.

If the arrangements made for delivery at the time of ordering are not convenient for me I am responsible for making any necessary alternative arrangements myself by contacting the supplier on the phone number below.

I am responsible for ensuring that I (or my representative) is at my home address to receive the item when it is delivered.

The make and model of the item will be decided by George House Trust on the basis of the information I have supplied and I will not be able to change or amend the order.

Welfare Fund:BED FRAME / MATTRESS

You are making an application for a BED FRAME and/or MATTRESS. You must read the following statements carefully. You will be asked to tick a box to indicate that you agree to these terms. If you are unable to agree to these terms, we will unfortunately not be able to proceed with your application for this item.

I acknowledge that, if my application is successful, the item requested above will be delivered to my home. The goods have been funded by the George House Trust Welfare Fund and the item will be supplied by the supplier chosen by George House Trust.

I understand and agree to the following:

If the item is faulty, or becomes faulty at a later date, I am responsible for contacting the supplier from where the item was bought.

The item will be delivered to my home address. This address is the one recorded on the George House Trust database.

If the arrangements made for delivery at the time of ordering are not convenient for me I am responsible for making any necessary alternative arrangements myself by contacting the supplier on the phone number below.

I am responsible for ensuring that I (or my representative) is at my home address to receive the item when it is delivered.

The make and specification of the item will be decided by George House Trust on the basis of the information I have supplied and I will not be able to change or amend the order.

Welfare Fund: WASHING MACHINE

You are making an application for a WASHING MACHINE. You must read the following statements carefully. You will be asked to tick a box to indicate that you agree to these terms. If you are unable to agree to these terms, we will unfortunately not be able to proceed with your application for this item.

I acknowledge that, if my application is successful, the item requested above will be delivered to my home. The goods have been funded by the George House Trust Welfare Fund and the item will be supplied by the supplier chosen by George House Trust.

I understand and agree to the following:

The washing machine will be fitted by a qualified installer, arranged through the supplier, and I am not permitted to arrange independent installation as an alternative. George House Trust will not supply washing machines which are not delivered brand new and which are not fitted by the supplier.

The Welfare Fund covers the cost of standard installation. Adequate water inlet and waste pipes and an electrical socket must be available in the vicinity of where the washing machine is to be located for the installation to take place.

My old appliance will be taken away by the supplier.

If the item is faulty, or becomes faulty at a later date, I am responsible for contacting the supplier from where the item was bought.

The item will be delivered to my home address. This address is the one recorded on the George House Trust database.

If the arrangements made for delivery at the time of ordering are not convenient for me I am responsible for making any necessary alternative arrangements myself by contacting the supplier on the phone number below.

I am responsible for ensuring that I (or my representative) is at my home address to receive the item when it is delivered.

The make and model of the item will be decided by George House Trust on the basis of the information I have supplied and I will not be able to change or amend the order.

Disclaimer Agreement *

Yes, I agree to the terms set out above

We will not be able to consider your application for the able item without your agreement to the above terms

How much are you applying for (item 2)? *£

Enter value to 2 decimal places e.g. 100.00

Grants for clothing are made by store vouchers for £75. You can make up to two claims for £75 for clothing in any one year. We do not make cash payments for clothing.

Bed sets and quilts will be available for collection from George House Trust. Bed sets are plain dyed sets consisting of a duvet cover, pillow cases and a sheet. Quilts will have polyester fibre filling and the TOG rating may vary. We do not make cash payments for bedding or quilts.

Grants for membership fees, eyecare or dental treatment, furniture items, or other items will be made either by direct payment to the provider or by home delivery from the supplier. We do not make cash payments for these items. Grants for carpeting/flooring are most likely to be made by direct payment to the supplier and you will be asked to send us a quotation from your supplier that matches the value you have indicated on your application. Due to the amount of funds available, we are likely to have to cap grants for carpeting/flooring at £250 and if your quotation is for a higher value, we may be able to consider making an arrangement with your supplier to meet the remaining cost, up to our maximum grant, where you are able to part pay the cost. We will not make retrospective cash payments to you for carpeting/flooring you have already had fitted.

Preferred store *

Primark

H & M

Dorothy Perkins

Evans

Burton Menswear

Miss Selfridge

Outfit

Top Shop

Top Man

Wallis

RESTRICTED SECONDARY ITEM (*)

PROCEED SECONDARY APPLICATION?

APPLICATION DETAIL

IMPORTANT NOTE: Please provide as much information as possible in your responses to the following questions. Your application is more likely to be accepted if you provide full supporting information as the Panel can more easily make a decision based on your circumstances and the reasons for your application.

Explain why you are unable to buy this (these) item(s) yourself *

Are you undergoing treatment or recuperating from any additional health problems? *

Yes

No

Please explain more here *

Explain how this (these) item(s) will benefit your HIV health *

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Living with HIV? Want to talk to us?
Call 0161 274 4499 or email: talk@ght.org.uk

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About GHT

George House Trust has been providing HIV support, advice and advocacy services to improve health outcomes since 1985. We are a service user centred organisation, with a diverse team of highly trained and knowledgeable staff and volunteers.